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FORM 1 STATEMENT OF 2005
Pleas print type your name, mailing
address, agency name, and position below:FINANCIAL INTERESTSLAST NAME FIRST NAME MIDDLE NAME :
.11 t 14_ \' f.^.FOR OFFICE
*Ikk^^USEONLY:MAILING
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What is pleas print type your?
Pleas print type refers to the information that needs to be provided or filled in a document.
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Individuals or entities who are instructed or requested to do so.
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The purpose of pleas print type your is to gather specific information or data for record-keeping or other purposes.
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